Am Fam Physician. 2002 Feb 1;65(3):482-488.
Parents often seek medical evaluation for a child with fever. Parents have misconceptions about fever and, in fact, tend to view it as a disease rather than a symptom. Approximately 20 years ago, the term “fever phobia” was coined to describe the numerous misconceptions of parents about fever in children. In a study conducted in 1980, 94 percent of caregiver participants believed that fever could cause side effects, 18 percent believed that a fever lower than 38.9°C (102°F) could cause brain damage and other serious consequences, and 16 percent believed that an untreated fever could rise as high as 43.4°C to 48.9°C (110°F to 120°F).
Crocetti and associates studied current parental attitudes toward fever to determine whether today's more aggressive laboratory testing and presumptive treatment for occult bacteremia have fostered fever phobia.
A cross-sectional survey was presented to caregivers at the time of hospital-based clinic visits. Caregivers were asked open-ended questions related to their beliefs and concerns about fever and fever management. Of the 340 caregivers who completed interviews, 84 percent were mothers. More than one half of the respondents were very worried about the potential harm of fever, a number that was similar to the results of the earlier study. However, there was a substantial increase in the number of caregivers who reported that they were not at all concerned about fever (10 percent versus 1 percent). Ninety-one percent of participants believed that an untreated fever could cause harmful effects. Compared with findings of the earlier study, more caregivers in the current study listed seizure as the number one potentially harmful effect of fever (15 percent versus 32 percent previously); fewer listed brain damage (45 percent versus 21 percent), delirium (12 percent versus 1 percent), and blindness (3 percent versus 1 percent) as harmful effects. In the current study, 14 percent were concerned that fever could be life threatening compared with 8 percent in the earlier study. Twenty-three percent of current caregivers reported checking their children's temperature every hour during febrile illnesses, and 52 percent reported checking their child's temperature every hour or more often if the child had a fever.
One fourth of present-day respondents would give temperature-lowering medication for fevers lower than 37.8°C (100°F). It was found, however, that many of these caregivers were administering antipyretics at incorrect dosing intervals: 14 percent of caregivers gave acetaminophen to their children every three hours or more often rather than every four hours, and 44 percent incorrectly gave ibuprofen at intervals of five hours or less rather than every six hours. Almost 75 percent of caregivers reported using sponging as a fever-reducing method, but 68 percent performed the technique incorrectly by using alcohol, cool water, or a cool rag.
The authors conclude that caregiver understanding of fever in children is often incorrect and incomplete, and has not improved significantly in the past 20 years. In particular, antipyretic treatment methods continue to be used incorrectly, thereby increasing the risk of toxicity. Caregivers must be educated by physicians about the physiologic usefulness of fever and the appropriate use of antipyretics.
Crocetti M, et al. Fever phobia revisited: have parental misconceptions about fever changed in 20 years?. Pediatrics. June 2001;107:1241–6.
Copyright © 2002 by the American Academy of Family Physicians.
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